An experimental study of exposure-based and emotion-focused interventions: Strange bedfellows, or a match made in heaven?

Exposure therapy is a considered to be the treatment of choice for anxiety disorders, but mechanisms of change underlying its effectiveness are currently being contested. Emotional processing theory postulates that habituation of fear is the primary predictor of change during exposure, while inhibitory learning theory challenges that and postulates that variability in the intensity of fear is the predictor of change. Moreover, recent evidence points towards verbalization of emotion as a predictor of change during exposure as well. The present study investigated these predictors using a sample of 41 college students in an analog experimental design in the context of an exposure task. The study found mixed support that verbalization of emotion plays a role in improving the behavioral outcomes after an exposure task. Habituation in fear, controlled for variability in the intensity of fear, predicted worse speech performance from before to after the experimental task, (β = -.63, p = .001), while variability in the intensity of fear, controlled for habituation, improved speech performance (β = .54, p = .008). At the same time, habituation in shame, when controlled for variability in the intensity of shame, predicted an improvement in state self-esteem from before to after the experimental task (β =.31, p = .009), while variability in the intensity of shame, when controlled for habituation in shame, predicted state self-esteem deterioration (β = -.35, p = .038). Physiological indices indicated that lower heart rate variability during the experimental task predicted worsening in self-esteem from before to after the task (β = -.18, p = .034), while habituation in fear (r(39) = .40, p = .014) and shame (r(39) = .56, p \u3c .001) was positively correlated with parasympathetic nervous system activity when controlled for variability in these emotional states

Does the depth of client experiencing predict good psychotherapy outcomes? A meta-analysis of treatment outcomes

The Experiencing Scale (EXP), a measure of client\u27s emotional processing, is often used in psychotherapy process research. While researchers agree that it predicts treatment outcomes, this relationship has not been systematically studied. This meta-analysis quantified the relationship between EXP and therapy outcomes using a total of 11 studies and 458 clients. Analysis indicated that peak EXP measured during the working phase was the strongest predictor of treatment outcomes, r = .236. Subgroup analyses indicated that working phase effects were moderated by the outcome measure modality. Early phase effects were moderated by the type of treatment and the treatment target. In accordance with the literature in the field, working phase EXP was found to be a significant predictor of clinical outcomes, although this relationship was influenced by a number of variables. Further research should look at the moderators between EXP and outcomes, and at processes that increase client experiencing

Does feeling bad, lead to feeling good? Arousal patterns during expressive writing.

Different psychotherapy theories describe process patterns of emotional arousal in contradictory ways. To control both treatment and therapist responsivity, this study sought to test dynamic patterns in the arousal of negative affect using a controlled experimental study of expressive writing. There were 261 participants (78% women; M = 21 years old; 56% White) who suffered unresolved traumas who were randomly assigned to an expressive writing task and asked to write about their deepest thoughts and feelings, or to a writing control. Participants wrote for 15 min on three consecutive days, completing the Positive Affect and Negative Affect Scale before and after each visit. Data across 6 time points were subjected to hierarchical linear modeling (HLM) and pattern analyses. Session-by-session (24 hr periods), the expressive writing group showed an overall linear decrease in negative affect (β = −2.273, p &lt; .001). However, in pre- to post-session ratings (15 min periods), the expressive writing group also demonstrated increases in negative affect (β = 6.467, p &lt; .001). Neither of these patterns were observed in the control group. Pattern analysis demonstrated 69.8% of cases in the expressive writing group perfectly or almost perfectly followed a predicted zig-zag pattern ( p &lt; .01). No control cases showed this pattern. Findings demonstrate how the habituation/inhibition hypothesis (“it gets easier as one gets over it”) and the meaning-making hypothesis (“it gets worse before it gets better”) can both be supported, each at different scopes of analysis. Implications clarify the role of emotional arousal in change. </jats:p